Orthopedic manifestation as the presenting symptom of acute lymphoblastic leukemia

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IntroductionThe diagnosis of Acute lymphoblastic leukemia (ALL) is delayed due to vague presentation and normal hematological investigations. ObjectiveThe objectives were to identify the frequency of ALL cases presented to the orthopedic department and with normal hematological investigations. Material and methods250 consecutive ALL cases were retrospectively evaluated to identify cases with musculoskeletal manifestations, and laboratory investigations. ResultsTwenty-two patients (4- vertebral compression fractures, 12- joint pain, 6- bone pain), presented primarily to the orthopedic department. Six patients had a normal peripheral smear. ConclusionThe primary physician should maintain a high index of suspicion despite a normal peripheral smear.